A customer enters a CVS store in October 2023 in Los Angeles. Pharmacies in Black and Latino neighborhoods and those with more residents on Medicaid are less likely to regularly dispense buprenorphine — one of the main medications used to treat opioid use disorder. (Photo by Mario Tama/Getty Images)

Pharmacies in Black and Latino neighborhoods are less likely to dispense buprenorphine — one of the main treatments for opioid use disorder — even though people of color are more likely to die from opioid overdoses.

The drug helps reduce cravings for opioids and the likelihood of a fatal overdose.

While the nation as a whole has seen decreases in opioid overdose deaths in recent years, overdose deaths among Black, Latino and Indigenous people have continued to increase.

Many medical and health policy experts fear the broad domestic policy law President Donald Trump signed in July will worsen the problem by increasing the number of people without health insurance. As a result of the law, the number of people without coverage will increase by about 10 million by 2034, according to the Congressional Budget Office.

About 7.5 million of the people who will lose coverage under the new law are covered by Medicaid. Shortly before Trump signed the bill into law, researchers from the University of Pennsylvania and Boston University estimated that roughly 156,000 Medicaid recipients will lose access to medications for opioid addiction because of the cuts, resulting in approximately 1,000 more overdose deaths annually.

Because Black and Hispanic people are overrepresented on the rolls, the Medicaid cuts will have a disproportionate effect on communities that already face higher barriers to getting medications to treat addiction.

From 2017 to 2023, the percentage of U.S. retail pharmacies regularly dispensing buprenorphine increased from 33% to 39%, according to a study published last week in Health Affairs.

But researchers found the drug was much less likely to be available in pharmacies in mostly Black (18% of pharmacies) and Hispanic neighborhoods (17%), compared with mostly white ones (46%).

In some states, the disparity was even worse. In California, for example, only about 9% of pharmacies in Black neighborhoods dispensed buprenorphine, compared with 52% in white neighborhoods.

The researchers found buprenorphine was least available in Black and Latino neighborhoods across nearly all states.

Barriers to treatment

Dr. Rebecca Trotzky-Sirr, a family physician who specializes in addiction medicine, said many communities of color are “pharmacy deserts.” Even the pharmacies that do exist in those neighborhoods tend to “have additional barriers to obtain buprenorphine and other controlled substances out of a concern for historic overuse of some treatments,” said Trotzky-Sirr, who wasn’t involved in the study.

In addition to its federal classification as a controlled substance, buprenorphine is also subject to state regulations to prevent illegal use. Pharmacies that carry it know that wholesalers and distributors audit their orders, which dissuades some from stocking or dispensing it.

Dima Qato, associate professor of clinical pharmacy at the University of Southern California and an author of the Health Affairs study, said that without changes in policy, Black and Hispanic people will continue to have an especially hard time getting buprenorphine.

“If you don’t address these dispensing regulations, or regulate buprenorphine from the aspect of pharmacy regulations, people are still going to encounter barriers accessing it,” she said.

In neighborhoods where at least a fifth of the population is on Medicaid, just 35% of pharmacies dispensed buprenorphine, Qato and her team found. But in neighborhoods with fewer residents on Medicaid, about 42% of pharmacies carried the drug.

Medicaid covers nearly half — 47% — of nonelderly adults who suffer from opioid use disorder. In states that expanded Medicaid under the Affordable Care Act, another recent study found an increase in people getting prescriptions for buprenorphine.

“Medicaid is the backbone of care for people struggling with opioid use disorder,” said Cherlette McCullough, a Florida-based mental health therapist. “We’re going to see people in relapse. We’re going to see more overdoses. We’re going to see more people in the ER.”

Qato said the shortage of pharmacies in minority communities is likely to get worse, as many independent pharmacists are already struggling to stay open.

“We know they’re more likely to close in neighborhoods of color, so there’s going to be even fewer pharmacies that carry it in the neighborhoods that really need it,” she said.

‘There needs to be urgency’

Qato and her colleagues say states and local governments should mandate that pharmacies carry a minimum stock of buprenorphine and dispense it to anyone coming in with a legitimate prescription. As examples, they point to a Philadelphia ordinance mandating that pharmacies carry the opioid overdose-reversal drug naloxone and similar emergency contraception requirements in Massachusetts.

“We need to create expectations. We need to encourage our pharmacies to carry this to make it accessible, same day, and there needs to be urgency,” said Arianna Campbell, a physician assistant and co-founder of the Bridge Center, a California-based organization that aims to help increase addiction treatment in emergency rooms.

“In many of the conversations I have with pharmacies, when I’m getting some pushback, I have to say: ‘Hey, this person’s at the highest risk of dying right now. They need this medication right now.’”

She said patients frequently become discouraged due to barriers they face in getting prescriptions filled. The Bridge Center has been expanding its patient navigator program across the state, and helping other states start their own. The program helps patients identify pharmacies where they can fill their prescription fastest.

“There’s a medication that can help you, but at every turn it’s really hard to get it,” she said, calling the disparities in access to medication treatment “unacceptable.”

Trotzky-Sirr, the California doctor, fears the looming Medicaid cuts will cause many of her patients to discontinue treatment and relapse. Many of her patients are covered by Medi-Cal, the state’s Medicaid program.

“A lot of our patients are able to obtain medications for treatment of addiction like buprenorphine, because of the state covering the cost of the medication,” said Trotzky-Sirr, who also is a regional coordinator at the Bridge Center.

“They don’t have the resources to pay for it, cash, out of pocket.”

Some low-income patients switch between multiple providers or clinics as they try to find care and coverage, she added. These could be interpreted as red flags to a pharmacy.

Trotzky-Sirr argued buprenorphine does not need to be monitored as carefully as opioids and other drugs that are easier to misuse or overuse.

“Buprenorphine does not have those features and really needs to be in a class by itself,” she said. “Unfortunately, it’s hard to explain that to a pharmacist in 30 seconds over the phone.”

More is known about the medication now than when it was placed on the controlled substances list about two decades ago, said Brendan Saloner, a Bloomberg Professor of American Health in Addiction and Overdose at Johns Hopkins University.

Pharmacies are fearful of regulatory scrutiny and don’t have “countervailing pressure” to ensure patients get the treatments, he said.

On top of that fear, Medicaid managed care plans’ prior authorization processes may also be adding to the pharmacy bottleneck, he said.

“Black and Latino communities have higher rates of Medicaid enrollment, so to the extent that Medicaid prior authorization techniques are a hassle to pharmacies, that may also kind of discourage them [pharmacies] from stocking buprenorphine,” he said.

In some states, buprenorphine is much more readily available. In Maine, New Hampshire, Oregon, Rhode Island, Utah and Vermont, more than 70% of pharmacies carried the drug, according to the study. Buprenorphine availability was highest in states such as Oregon that have the least restrictive regulations for dispensing it.

In contrast, less than a quarter of pharmacies in Iowa, North Dakota, Texas, Virginia and Washington, D.C., carried the medication.

“We’re going to see more people becoming unhoused, because without treatment, they’re going to go back to those old habits,” McCullough, the Florida therapist, said. “When we talk about marginalized communities, these are the populations that are going to suffer the most because they already have challenges with access to care.”

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

First District U.S. Rep. Bryan Steil (R-Janesville) holds an in-person listening session at Elkhorn High School in Elkhorn, Wisconsin, Thursday evening July 31, 2025. (Copyright Mark Hertzberg/for Racine County Eye)

ELKHORN — At a raucous listening session in a high school auditorium Thursday evening, U.S. Rep. Bryan Steil (R-Janesville) defended the immigration and tariff policies of  President Donald Trump and the Republican budget reconciliation law that Trump signed on July 4.

From the roars of the crowd, critics of the congressman appeared to account for the majority of the group that filled nearly two-thirds of the 600-seat Elkhorn High School auditorium. But there were also recurring cheers, shouts and applause at key moments from a smaller coterie of supporters in the room.

Steil represents the 1st District in Congress, which covers Southeastern Wisconsin from Janesville and Beloit east to Racine and Kenosha on the shores of Lake Michigan.

Over the last several months, Republican members of Congress have been counseled not to hold in-person events with constituents after publicity about angry crowds turning up at some GOP town halls.

Steil’s constituents have been protesting weekly outside his office in Racine for months, calling on him to hold an in-person meeting rather than telephone ones. 

Taking the stage shortly after 5 p.m. and lasting for about 80 minutes there, Steil stuck with a cheerful, breezy tone. He treated the loud, impassioned and often angry audience cries as mostly a difference of opinion.

When an audience member asked Steil how he might take a stand against other congressional Republicans “who lie to the American public and malign the dignity of 70 million people on Medicaid by suggesting that they are lazy,” Steil lamented the tone of political discourse and vowed not to denigrate anyone. Then he turned the subject back to the boisterous auditorium.

“I’d say the overall majority of people here want to learn and understand my perspective, want to hear the question,” he said. “And then there’s a small group of people that are challenging.”

It was left to the moderator of the session, Janesville radio host Tim Bremel, to lecture the crowd to refrain from shouting over Steil’s answers during a Q&A period.

During one interruption, the radio host scolded, “Ladies and gentlemen, we will never get questions if we can’t keep the auditorium quiet. And please do the person who asked the question the respect of allowing his question to be answered.”

Pledge of Allegiance

Steil kicked off the session with the Pledge of Allegiance, inviting the audience to join him. They did so, some shouting the final words “and justice for all” with vehemence.

He followed with a short talk offering “just kind of an overview of where we’re at in this country to get ourselves back on track” — words that prompted more angry taunts.

Steil said that the nation’s spending is about “$1.8 trillion more than on the revenue side,” a comment that prompted scattered shouts scoffing at “tax breaks.”

He defended the expansion in the budget reconciliation law of work requirements for SNAP food aid, saying the change followed a model that Wisconsin had already instituted for the program in the 1990s.

When he switched to immigration and a graph that Steil said showed “the dramatic drop, the decrease that we have seen in border apprehensions,” a cry of “We are all immigrants!” came up from several rows of seats.

Nine minutes in, Steil made a pitch for his office’s constituent services, then appealed for restraint from the crowd.

“The more civil we are with each other — there’s people that have different views in here, we heard applause and boos on the border security issue, we’ve heard it a couple of times,” he said. “We have people on all sides, it’s great, that’s what makes us so great.”

Tariffs, ICE and deportation

The questions that followed came from members of the audience who filled out forms at tables in the school lobby.

Bremel told the crowd that the questioners would be chosen at random. Some greeted that claim with loud skeptical scoffs. Over the course of the hour, however, the vast majority of people who were chosen asked questions sharply critical of Steil, Trump, the Republican congressional majority, or all three.

Criticizing Trump’s tariffs, Tom Burke asked Steil “what dire economic circumstances” justified the president’s executive orders to impose them.

“What we need to do is make sure that we’re having other countries treat the United States fairly,” Steil replied, adding that the U.S. should “work collectively with our allies to address the real culprit, which is China.”

Burke wasn’t satisfied with the answer. U.S. allies, “seem to be alienated beyond belief,” he told Steil, adding that until he got a satisfactory answer to his question about their rationale, “I’m going to be totally opposed to these tariffs — period.”

Specifying that her question was about “not politics, but morality,” Jean Henderson of Elkhorn told Steil, “What I see happening to our immigrant population embarrasses me, terrifies me.”

Henderson criticized the deployment of Immigration and Customs Enforcement (ICE) personnel, their faces hidden by masks, against immigrants “who are doing the right thing by going to the immigration office,” only to be taken into custody. “It is a trap,” she said. “Why is this happening and why aren’t you stopping it?”

Steil began in reply, “What I view is the moral hazard created by the Biden administration…,” prompting a roar of disapproval from the crowd, then a shout of “Joe Biden sucks!” from someone perhaps more sympathetic to the congressman.

The rest of Steil’s response was largely drowned out.

When it was her turn at the microphone, Kelly Neuens connected the experiences of her grandparents and great aunt and great uncle, who were held in U.S. internment camps during World War II as U.S. citizens of Japanese descent, to the conditions in the El Salvador prison where the Trump administration has sent some immigrants taken into custody.

“President Trump said, ‘Homegrowns are next’ when he was speaking to the El Salvador president,” Neuens told Steil. “My worry is that we are repeating history here.”

A plea for the climate

In his answer, which was repeatedly interrupted, Steil described the World War II internment as “one of the more darker chapters of American history,” then added, “As we look at the engagement that law enforcement is doing now against immigrants who are in the country illegally, I don’t see the  exact parallel.”

Another questioner asked Steil to explain “why you support Linda McMahon and defunding the Department of Education?”

Congress, Steil said, is still “analyzing what the spending will be for the upcoming fiscal year.” He added that the department “has burdened a lot of our local school districts with unnecessary red tape” in the course of distributing funds to the states. “I think what we will see as we negotiate this going forward is a way to make sure that those funds are there” for local schools, he said.

When it was her turn to ask a question, Sharna Ahern of Fontana thanked Steil and his staff “for answering all the contacts I’ve made with you over the years.”

She enumerated a wide range of concerns she has had — about the Department of Education, about the treatment of immigrants, “about the rule of law and civil rights” — and then turned her focus on the environment.

“Extreme weather conditions are happening more frequently as we experience them,” she told Steil. “The EPA is deregulating the standards that are in place to fight climate change, to protect the citizens. Where do you stand on this issue? And how can you be an advocate for us to initiate legislation to restore our safeguards?”

Steil praised Wisconsin as “one of the most beautiful states in the country” and asserted that “making sure that we’re protecting our air and water and soil is absolutely essential.” He said that on the issue of climate change, “what we need to be doing is focused on addressing that global aspect. But again, make sure other countries are doing their fair share of it.”

The crowd largely jeered at the response. When another audience member asked about Trump’s executive orders rolling back Biden administration measures to address climate change, Steil said that action was necessary to “correct … the overreach in the previous administration.”

It was after 6 p.m. when Bremel called for the final question.

A few minutes earlier, someone had shouted a question about “children starving in Gaza,” and the woman whose turn it was asked Steil to address that topic as well as to defend the SNAP cuts.

“I can do them both,” Steil said. He started with SNAP, reiterating his earlier assertion that Wisconsin would not be affected by the program’s changes to work requirements because of policies the state had in place already.

Turning to Gaza, Steil said, “To me the easy answer to address this crisis is for Hamas to surrender and release the hostages. Release them. Israel was unfairly, unjustly attacked.”

His comments gave rise to another brief demonstration, punctuated by repeated chants of “60,000 people are dead!”

By the time the chanting ended, Steil had left the stage. 

The photos accompanying this report are not available for republishing except by agreement with photographer Mark Hertzberg. 

The Lyndon Baines Johnson Department of Education Building pictured on Nov. 25, 2024. (Photo by Shauneen Miranda/States Newsroom)

WASHINGTON — U.S. Senate Democrats on Thursday slammed the “assault” on public education by President Donald Trump’s administration, underscoring the impact of billions of dollars in funds still frozen for K-12 schools and ongoing efforts to dismantle the Education Department.

Hawaii Sen. Mazie Hirono, who hosted a forum alongside several Democratic colleagues that also heard testimony from education leaders, advocates and leading labor union voices, said Trump is engaged in “an all-out, coordinated attack on public education.”

The agency has seen a dizzying array of cuts, overhauls and changes since Trump took office as he seeks to dramatically redefine the federal role in education and take an axe to the agency.

This month, the U.S. Supreme Court temporarily cleared the way for the administration to carry out mass layoffs and a plan to dramatically downsize the Department of Education that Trump ordered earlier this year.

“How can we expect our schools to plan for the upcoming school year when they are confronted with chaos and uncertainty from this administration?” Hirono said at the forum.

Compounding the issue, the administration garnered bipartisan backlash after notifying states that it would be withholding $6.8 billion in funds for K-12 schools just a day before July 1, when these dollars are typically sent out as educators plan for the coming school year.

The administration last week confirmed the release of a portion of those funds that support before- and after-school programs and summer programs, totaling $1.3 billion, but it has yet to release the remaining $5.5 billion that go toward migrant education, English-language learning, adult education and literacy programs, among other initiatives.

“How dare they take the monies that you appropriated, that schools need right now, as schools start in the next two weeks, taking it away from summer school, from after-school, from kids that need English-language acquisition — how dare they do that?” Randi Weingarten, president of the American Federation of Teachers, said at the forum.

“How come we have to constantly go in and sue them and sue them and sue them to get things that you already appropriated?” said Weingarten, who leads one of the country’s largest teachers unions.

Jacqueline Rodriguez, CEO of the National Center for Learning Disabilities, said the withheld money was devastating to students with disabilities.

“This funding delay is sabotaging student learning, educator preparedness and essential services, causing heavy impacts on those students with disabilities,” she said.

“To educators, this isn’t a delay, it’s a breach of public trust,” she said, adding that the freeze is “forcing schools to make tough choices about how they now have to reallocate funding.”

National school voucher program

The forum also took aim at a sweeping national school voucher program included in the mega tax and spending cut bill that Trump signed into law July 4.

The permanent program starts in 2027 and allocates up to $1,700 in federal tax credits for individuals who donate to organizations that provide private and religious school scholarships.

“What we are seeing is just a wholesale dismantling and disruption of the public education system,” said Denise Forte, president and CEO of the nonprofit policy and advocacy group EdTrust.

“And with this new national voucher scheme — which is exactly what it is — that’s really about making sure that students from wealthier families who had already been participating in private schooling will have access to even more public dollars.”

Former Education secretary speaks out

Earlier Thursday, former U.S. Education Secretary Miguel Cardona also criticized Trump’s “attacks” on education, including the billions of dollars in frozen funds.

“The irony is, this is really impacting many of the communities that really were rooting for this current administration,” Cardona, who was Education secretary under then-President Joe Biden, said on a press call hosted by Defend America Action that also featured Karen Smith, a member of Pennsylvania’s Central Bucks School District School Board as well as Nick Melvoin, a member of the Los Angeles Unified School District Board of Education.

“They’re being impacted the most in many ways,” Cardona said. “I always say, all students are going to be impacted, but the students furthest from opportunity are going to be impacted the most and more severely and more quickly, so let’s put that perspective on what’s happening in education — policies have consequences, and the consequences are going to be felt for decades, just from what was done in the last five months.” 

People listen to a sermon before being admitted to lunch at the Hope Center, which assists homeless and addicted residents in Hagerstown, Md. Experts say Medicaid cuts will exacerbate rural communities’ access to mental health care. (Photo by Spencer Platt/Getty Images)

Across the nation, Medicaid is the single largest payer for mental health care, and in rural America, residents disproportionately rely on the public insurance program.

But Medicaid cuts in the massive tax and spending bill signed into law earlier this month will worsen mental health disparities in those communities, experts say, as patients lose coverage and rural health centers are unable to remain open amid a loss of funds.

“The context to begin with is, even with no Medicaid cuts, the access to mental health services in rural communities is spotty at best, just very spotty at best — and in many communities, there’s literally no care,” said Ron Manderscheid, former executive director of the National Association of County Behavioral Health and Developmental Disability Directors.

Cuts over the next 10 years could force low-income rural families to pay for mental health care out of pocket on top of driving farther for care, experts say. Many will simply forgo care for depression, bipolar disorder and other illnesses that need consistent treatment.

“Not only do you have very few services available, but you don’t have the resources to pay for the services,” Manderscheid said. “That makes the problem even worse.”

Rural communities are already at higher risk of suicide, with rates almost doubling over the past two decades. Already, rural communities are grappling with a shortage in mental health professionals, making them more vulnerable to losses compared with more urban areas, experts say.

Paul Mackie, assistant director of the Center for Rural Behavioral Health at Minnesota State University, Mankato, studies rural mental health workforce shortages.

“If it [coverage] goes away, what would then be the person’s next option if they already don’t have the resources?” said Mackie, who grew up on a rural Michigan dairy farm. “You can have a rural psychologist or a rural clinical social worker working under a shingle, literally alone.”

Small rural hospitals often provide critical behavioral health care access, he said. One analysis found the cuts next year would leave 380 rural hospitals at risk of shutting down.

States such as Mackie’s Minnesota, which expanded Medicaid eligibility under the 2010 Affordable Care Act, would suffer significant slashes in federal matches as a result of President Donald Trump’s signature legislation. The law, which includes tax cuts that disproportionately benefit the wealthy, cuts the federal government’s 90% matching rate for enrollees covered under expansion to anywhere from 50% to 74%.

States will have to redetermine eligibility twice a year on millions enrolled under Medicaid expansion. Some Medicaid recipients also will have to prove work history. The new law creates work requirement exceptions for those with severe medical conditions — including mental disorders and substance use — but experts say proving those conditions may be convoluted. The exact qualifications and diagnoses for the exceptions haven’t been spelled out, according to a report by KFF, a health policy research organization.

“You can’t work when your mental illness is not treated,” said Dr. Heidi Alvey, an emergency and critical care medicine physician in Indiana. “It’s so counter to the reality of the situation.”

Alvey worked seven years at Baylor Scott & White Health’s hospital in Temple, Texas. As nearby rural critical access hospitals and other mental health centers shut down, the hospital became the only access point for people hours away, she said.

“People who just had absolutely no access to care were coming hours in to see us,” she said. Many had serious untreated mental health conditions, she said, and had to wait days or weeks in the emergency department until a care facility had an open bed.

She’s concerned that Medicaid cuts will only make those problems worse.

Jamie Freeny, director of the Center for School Behavioral Health at advocacy group Mental Health America of Greater Houston, worries for the rural families her center serves. The organization works with school districts across the state, including those in rural communities. Nearly 40% of the state’s more than 1,200 school districts are classified as rural.

She remembers one child whose family had to drive to another county for behavioral health. The family lost coverage during the Medicaid unwinding, as pandemic provisions for automatic re-reenrollment expired. The child stopped taking mental health medication and ended up dropping out of school.

“The child wasn’t getting the medicine that they needed, because their family couldn’t afford it,” Freeny said. “The catalyst for that was a lack of Medicaid. That’s just one family.

“Now, you’re multiplying that.”

Family medicine physician Dr. Ian Bennett sees Medicaid patients at the Vallejo Family Health Services Center of Solano County in California’s Bay Area. The community health clinic serves patients from across the area’s rural farm communities and combines primary care with mental health care services, Bennett said.

“When our patients lose Medicaid, which we expect that they will, then we’ll have to continue to take them, and that will be quite a strain on the finances of that system,” Bennett said. The center could even close, he said.

“The folks who are having the most difficulty managing their lives — and that’s made worse by having depression or substance use disorder — are going to be the folks most likely to drop off,” said Bennett, a University of Washington mental health services researcher. “The impacts down the road are clearly going to be much worse for society as we have less people able to function.”

The psychiatric care landscape across Michigan’s rural western lower peninsula is already scarce, said Joseph “Chip” Johnston. He’s the executive director of the Centra Wellness Network, a publicly funded community mental health care provider for Manistee and Benzie counties. The network serves Medicaid and uninsured patients from high-poverty communities.

“I used to have psychiatric units close by as an adjunct to my service,” he said. “And they’ve all closed. So, now the closest [psychiatric bed] for a child, for example, is at least two hours away.”

Those facilities are also expensive. A one-night stay in an inpatient psychiatric facility can be anywhere from $1,000 to $1,500 a night, he said.

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org.

Shelley Feist, 61, of Washington, D.C., who was raised in North Dakota, protests outside the U.S. Capitol on Wednesday, July 2, 2025, as House Republicans try to pass the "big beautiful bill." Feist said she's worried about effects on rural hospitals as a result of Medicaid cuts because her parents, in their 80s, depend on rural health care in Minot, North Dakota. (Photo by Ashley Murray/States Newsroom)

WASHINGTON — Protesters demonstrated against the “big beautiful bill” outside the U.S. Capitol Wednesday as House Republicans whipped votes to get the bill across the finish line and to President Donald Trump’s desk by a self-imposed July Fourth deadline.

Shelley Feist stood on Independence Avenue near the entrance to the House of Representatives holding signs above her head, one reading “Cruel Corrupt Cowards,” the other a Republican elephant with the word “Treason” written on it.

“I think they’re being cruel. I think cruelty is the point,” Feist, 61, of Washington, D.C., and originally from North Dakota, told States Newsroom. “It’s also extremely alarming that there’s such cowardice in the GOP.”

The massive budget reconciliation package, passed by Senate Republicans Tuesday with a tie-breaking vote by Vice President JD Vance, extends and expands 2017 tax cuts at a cost of roughly $4.5 trillion over the next decade. It also yanks funding from federal food and health safety net programs.

The bill aggressively rolls back clean energy tax credits, as well as raising the nation’s borrowing limit to $5 trillion.

Latest figures from the nonpartisan Congressional Budget Office show the package would add $3.4 trillion to the nation’s deficit over the next decade, when the country is mired in record-breaking debt. That office’s earlier analysis of the House-passed bill found the package would reduce resources for low-income families while padding higher earners.

Rep. Virginia Foxx of North Carolina, who chaired an hours-long final committee hearing about the bill overnight, said Wednesday the package is an “embodiment of the America First agenda and we would all do well to remember that.”

Medicaid cuts

Top of mind for Feist is the bill’s cuts to Medicaid, the federal-state health insurance program for low-income individuals and some with disabilities. The Senate version of the package, passed Tuesday, included a  $1 trillion cut to Medicaid over 10 years, according to the CBO.

“I have parents in North Dakota who are 85 and 86. They already have difficulty seeing their doctor. For every doctor that leaves, he takes on 14 times more burden. Rural health care is already extremely difficult. I would expect there will not be a hospital near where my parents live if this bill is signed into law,” said Feist, whose parents live near Minot.

Rural hospitals rely on Medicaid payments. In a last-minute move before Tuesday’s vote, Senate Republicans doubled a fund to $50 billion to subsidize hospitals that will lose funding. Critics say that amount is not enough to fill the gap.

GOP Sens. Susan Collins of Maine and Thom Tillis of North Carolina voted no after voicing concerns over Medicaid cuts.

Nadine Seiler, 60, of Waldorf, Maryland, stood near a press conference by the Congressional Hispanic Conference protesting the bill. Seiler held a large spray-painted sheet above her head with a message on each side: “Free America from Big Bad Bill” and “Coming Soon Freedom in Name Only.”

“I’m concerned about my fellow citizens who are going to be losing Medicaid, food stamps, human health services. People are going to die,” Seiler said.

“And I know Joni Ernst says that we all gonna die, but we gonna die faster and unnecessarily and I care about that.”

Seiler was referring to Sen. Ernst’s response to her Iowa constituents who expressed concern about Medicaid cuts at a town hall on May 30.

SNAP and ICE

Mark Starr sang a protest song he wrote about the “big beautiful bill” as he played guitar and harmonica outside the Longworth House Office Building Wednesday.

The 39-year-old Albuquerque, New Mexico, native told States Newsroom he drove to the capital in late April to begin protesting the bill. He said he’s particularly focused on additional funding for Immigration and Customs Enforcement contained in the package as well as cuts to the Supplemental Nutrition Assistance Program, or SNAP, which provides food benefits to low-income households.

“New Mexico is pretty poor, and so if these cuts to SNAP go, kids can go hungry in New Mexico,” Starr said. “It’s just, like, really gonna mess us up, and we’re just one of the many states that will be affected that way.”

New Mexico has one of the highest poverty rates in the nation.

A provision in the bill will shift food assistance costs to state governments for the first time in the federal program’s history. Critics worry that states could tighten eligibility requirements or drop the program because of the financial burden.

The left-leaning Center for Budget and Policy Priorities estimates 55,000 teens age 14 and up, and adults up to age 64 could lose food assistance in New Mexico because of the bill’s cuts to state work requirement waivers. Children would remain eligible but households would overall see significantly decreased SNAP dollars.

The CBO found in late May that the House-passed bill would result in over 3 million people nationwide losing food assistance.

Starr said he’s also against additional funding provided for immigration enforcement.

“I think they have enough,” he said, pointing to Trump’s visit to a new detention facility in Florida that the White House is touting as “Alligator Alcatraz.”

The Senate-approved version includes an additional $45 billion for ICE detention facilities and $29.9 billion for ICE enforcement and deportation, among billions more directed toward the Southern border.

Clean energy to take a hit

Tiernan Sittenfeld, of the League of Conservation Voters, huddled just outside the House with a group wearing t-shirts that read “Hands off our air, land and clean energy.”

Sittenfeld, the organization’s senior vice president of government affairs, argues the rollbacks of clean energy tax credits in the Senate version will “kill clean energy jobs.”

“It is bad for our economy. It’s bad for jobs. It’s going to raise people’s energy bills. And of course, it’s bad for the planet,” she said.

Senate Republicans accelerated the phase-out of some residential, manufacturing and production credits at a faster rate than the House bill. A last-minute change loosened the timeline on some tech-neutral energy credits though, and removed a previously added tax on wind and solar projects.

Industry groups and energy companies small and large have warned early termination of the credits will have a major impact on growth.

The tax credits for solar, wind, batteries for energy storage, and electric vehicles, among others, were enacted under Democrats’ own 2022 budget reconciliation bill known as the “Inflation Reduction Act.”

The majority of investment in new clean energy manufacturing and production has been concentrated in rural states and states that elected Trump to his second term, according to data collected since 2022 by the Clean Investment Monitor, a joint project by the Rhodium Group and the Massachusetts Institute of Technology’s Center for Energy and Environmental Policy Research.

“Any Republican who votes for this legislation is voting against the interest of their constituents, voting to kill jobs in their district, voting to kill clean energy projects, voting to make their constituents’ energy bills go up,” Sittenfeld said.

Far-right House members who as of Wednesday afternoon were withholding their votes maintain the rollbacks on the clean energy tax cuts, which they’ve dubbed the “green new scam,” do not go far enough.

Reading Time: < 1 minute

Nonpartisan analysts estimate that President Donald Trump’s megabill would add at least $2 trillion to the national debt over 10 years.

The Congressional Budget Office’s preliminary estimate says the tax-and-spending bill now in Congress will add $2.3 trillion.

Other estimates are higher: Tax Foundation: $2.56 trillion; University of Pennsylvania’s Penn Wharton Budget Model: $2.79 trillion; Committee for a Responsible Federal Budget: $3.1 trillion, including interest payments.

Some estimates under $2 trillion account for projected economic growth, while other estimates over $5 trillion note some provisions in the bill are temporary and will likely be extended.

The debt, which is the accumulation of annual spending that exceeds revenues, is $36 trillion.

U.S. Rep. Gwen Moore, D-Milwaukee, and U.S. Sen. Ron Johnson, R-Wis., claimed the bill would add trillions.

Among other things, the bill would make 2017 individual income tax cuts permanent, add work requirements for Medicaid and food assistance, and add funding for defense and more deportations.

This fact brief is responsive to conversations such as this one.

Sources

• The Hill: GOP beats down key budget office over tax plan projections
• Committee for a Responsible Federal Budget: CBO's First Score of House Reconciliation Bill
• Tax Foundation: “Big Beautiful Bill” House GOP Tax Plan: Preliminary Details and Analysis
• Penn Wharton Budget Model: The House-Passed Reconciliation Bill: Illustrative Budget, Economic, and Distributional Effects with Permanence
• Committee for a Responsible Federal Budget: Breaking Down the One Big Beautiful Bill
• Wisconsin Watch: Did the US debt increase by $7.8 trillion during Donald Trump’s presidency?
• U.S. Treasury Department: Debt to the Penny
• U.S. Rep. Gwen Moore: Congresswoman Moore Slams Republican Cuts to Health Care to Pay for Tax Giveaways for the Wealthy
• PBS Wisconsin: Ron Johnson says Trump can't bully him off his deficit-reducing demands for a federal budget bill
• Associated Press: Trump’s ‘beautiful’ bill spans more than 1,000 pages. Here’s what’s inside it

Is Donald Trump’s megabill projected to add more than $2 trillion to the national debt? is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.